Deinstitutionalization and Murder

Deinstitutionalization and Murder

This June 9, 2008 Wall Street Journal article by E. Fuller Torrey points to some recent research about the consequences of destroying the mental health system:

Numerous studies have documented the tragic effects of releasing hundreds of thousands of seriously mentally ill individuals from state hospitals while failing to ensure that they receive treatment.

The latest, carried out by Jason Matejkowski and colleagues at the University of Pennsylvania, found that individuals with serious mental illnesses are responsible for 10% of all homicides in Indiana. That translates into approximately 1,700 out of 17,034 total homicides in the U.S. in 2006. Over the past 20 years – during which time the public mental-health system has progressively deteriorated – that would mean 38,000 of 388,311 total homicides.

The University of Pennsylvania study examined the records of 723 individuals convicted of homicide between 1990 and 2002 in the Hoosier state. The results were published in the Journal of the American Academy of Psychiatry and the Law.

Examples of such homicides include Joseph Corcoran, diagnosed with paranoid schizophrenia, who shot four people in Fort Wayne because he thought they were talking about him. And Frank Salyers, also diagnosed with paranoid schizophrenia, who killed a policeman in Goshen after his parents tried unsuccessfully to get treatment for him at a local mental-health facility.

Although the Indiana study is the largest research of its kind in the U.S., two earlier but smaller studies reported that seriously mentally ill individuals were responsible for 10% of homicides in Contra Costa County, Calif., and 29% of homicides in Albany County, N.Y.

Most of these homicides were preventable, since the perpetrators in most cases were not being treated. Nontreatment, a past history of violent behavior and substance abuse are strong predictors of potential dangerousness in this population. We have proven options for decreasing such violence, including outpatient commitment. These programs require mentally ill individuals at high risk for violence to continue taking medication as a condition for living in the community.

I'm not happy that Fuller is still using the misleading comparison of:

In 1955, there were 559,000 individuals in America's state mental hospitals. By 2005, there were only 47,000 state hospital beds left in the country, a number that continues to fall.

It's true, but leaves out that some of the decline was because of other factors.

1. Transinstitutionalization--moving of the largely senile elderly from state mental hospitals to nursing homes as a result of passage of the Medicare Act.

2. The near disappearance of syphilitic insanity in the 1960s because of the introduction of antibiotics in the 1940s.

3. The rather dramatic increase in private mental hospitals in the 1960s and 1970s.

His point is still valid; his use of these numbers exaggerates somewhat a very real and tragic change.